This letter discusses the study by Liu et al recently published in World Journal of Psychiatry,which examines the benefits of combining epirubicin(EPI)with mindfulness interventions for patients with urinary system tu...This letter discusses the study by Liu et al recently published in World Journal of Psychiatry,which examines the benefits of combining epirubicin(EPI)with mindfulness interventions for patients with urinary system tumors and depre-ssion.The study included 110 patients and compared an experimental group receiving EPI and a mindfulness intervention strategy with a control group treated with mitomycin and standard care.Results showed that the experimental group had significant improvements in immune function,tumor markers,depression severity,quality of life,cancer-related fatigue,and nursing satisfac-tion.Despite acknowledging the study limitations such as a relatively small sample size and a short duration,the study highlights the efficacy of integrating mindfulness interventions into cancer treatment strategies to enhance patient outcomes and address psychological distress.展开更多
This paper systematically reviews the research progress of Advance Care Planning(ACP)in the field of lung cancer,and discusses its implementation status,key influencing factors and future development direction,includi...This paper systematically reviews the research progress of Advance Care Planning(ACP)in the field of lung cancer,and discusses its implementation status,key influencing factors and future development direction,including deepening of theoretical research,innovation of practice mode,optimization of policy support and cultural adaptation research.展开更多
Objective: Regular cancer screening must be monitored to improve gastric cancer(GC) survival rates and maximize participation. This study examined adherence to regular GC screening over a 10-year period and identified...Objective: Regular cancer screening must be monitored to improve gastric cancer(GC) survival rates and maximize participation. This study examined adherence to regular GC screening over a 10-year period and identified the factors influencing adherence.Methods: This retrospective cohort study was conducted using data from the Korean National Cancer Screening Program(KNCSP) between 2011 and 2020. The total cohort comprised 400,113 adults aged 40 years who were newly eligible for and participated in GC screening in 2011. The participants were followed up for 10 years to assess their adherence to biennial screening recommendations. They were categorized into two groups: the nonregular screening(non-RS) group, which included individuals who did not participate in subsequent screenings, and the regular screening(RS) group, which included those who participated in at least one follow-up screening.Multiple logistic regression analyses were performed to identify the factors associated with adherence to regular GC screening.Results: Over 10 years, 59% of the participants completed at least four of the five recommended screenings,while 10% did not participate after their initial screening. Male participants had higher odds of non-adherence than females [adjusted odds ratio(aOR)=1.429, 95% confidence interval(95% CI): 1.394-1.464;P<0.001]. Nonadherence was more prevalent among self-employed individuals(aOR=1.208, P<0.001). Among males, those in the lowest income group were 1.267 times more likely to not undergo regular screening than those in the highest income group.Conclusions: Long-term adherence to regular GC screening in South Korea remains suboptimal.Socioeconomic disparities persist, highlighting the need for tailored interventions to improve adherence and enhance public health.展开更多
Streptococcus pneumoniae is a known notorious cause of invasive pneumococcal diseases as well as asymptomatic host carriage. Efforts have been made to curb this infectious organism through various vaccine strategies. ...Streptococcus pneumoniae is a known notorious cause of invasive pneumococcal diseases as well as asymptomatic host carriage. Efforts have been made to curb this infectious organism through various vaccine strategies. However, its several strains and serotypes have necessitated various vaccine schedules and updates in the USA and globally. The evolution in pneumococcal vaccine schedules is not without challenges, such as cost, vaccine hesitancy, uptake and global disparities. This narrative review synopsizes the history of the Pneumococcal Vaccine and changes in its schedules in the last two decades based on published data. We focused on the impact of pneumococcal vaccination on invasive pneumococcal diseases, historical limitations, current challenges and future directions. Despite advancements in vaccination against S. pneumoniae infections, some pertinent issues exist that need to be swiftly fixed, to reduce national and thus global burden of pneumococcal diseases.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a global health concern,representing the second most common cause of malignancy-related mortality in the world.The primary cause of HCC in the United States is chronic infect...BACKGROUND Hepatocellular carcinoma(HCC)is a global health concern,representing the second most common cause of malignancy-related mortality in the world.The primary cause of HCC in the United States is chronic infection with the hepatitis C virus(HCV).Clinical observations have established sex-based differences in HCV infection with the disease progressing more severely and more rapidly in males and postmenopausal females compared to premenopausal females,suggesting that estrogens and their receptors may play an important role in hepatic defenses and development of HCV-mediated HCC.However,the precise mechanism of estrogen protection and their effects on inflammation is poorly understood.AIM To determine whether estrogen receptor(ER)expression is correlated with the expression of tumor necrosis factor-alpha(TNF-α)in males and females with HCV-associated diseases.METHODS The role of ERs in modulating innate immune responses was investigated using human liver tissues with HCV/cirrhosis and HCV/HCC.Messenger RNA(mRNA)and protein(nuclear and cytoplasmic)expression were measured for all markers of interest and compared to normal human liver tissue samples.RESULTS ERβwas reported for the first time to have a greater mRNA expression than ERαin normal liver(P≤0.001).In addition,ERβmRNA expression was found to be decreased in diseased livers(P≤0.05),while TNF-αexpression was increased(P≤0.0001).Upon stratifying by sex within each disease group,ESR1 was found to be negatively correlated with ESR2 in females with HCV/cirrhosis(r=-0.84,P≤0.001),whereas males with HCV/cirrhosis were found to have a significant positive correlation(r=0.57,P≤0.05).ESR2 mRNA expression had a significant positive correlation with TNF-αin both HCV/cirrhosis(r=0.61,P≤0.001)and HCV/HCC patients(r=0.45,P≤0.05).CONCLUSION All together,these findings indicate that changes in ERβand TNF-αexpression are associated with worsening disease,and may be part of the sex-dependent factors in HCC pathogenesis.展开更多
We investigated factors contributing to mobile phone dependence. To 139 medical students, we administered a self-reporting questionnaire designed to evaluate mobile phone dependence, health-related lifestyle, patterns...We investigated factors contributing to mobile phone dependence. To 139 medical students, we administered a self-reporting questionnaire designed to evaluate mobile phone dependence, health-related lifestyle, patterns of behavior, and depressive state. Multivariate logistic regression analysis revealed that scores for poor health-related lifestyle, Type A behavior pattern, and presence of depression are independently associated with degree of mobile phone dependency. These findings suggest that persons with an unhealthy lifestyle, Type A behavior traits, or depression might benefit from mobile phone use guidance.展开更多
BACKGROUND There are only a few studies on the influence of economic inequalities on youngonset type 2 diabetes(T2D).AIM To examine the impact of different family incomes on the development of youngonset T2D.METHODS W...BACKGROUND There are only a few studies on the influence of economic inequalities on youngonset type 2 diabetes(T2D).AIM To examine the impact of different family incomes on the development of youngonset T2D.METHODS We identified 7505336 young adults aged 20-39 years from the 2008 Taiwan region Health Insurance Research Database,China.The young adults were divided into low-income,middle-income,and high-income groups.Cox proportional hazards models were used to determine the risks of young-onset T2D and all-cause mortality in low-income and middle-income groups compared with the highincome group.RESULTS With a mean follow-up of 8.0 years,the incidence rates of young-onset T2D were 3.39,3.10,and 2.88 per 1000 person-years in the low-income,middle-income,and high-income groups,respectively.Compared with the high-income group,the risk of young-onset T2D was significantly higher in the low-income[adjusted hazard ratio(aHR)(95%CI):1.46(1.44–1.48)]and middle-income[aHR(95%CI):1.29(1.27–1.31)]groups.All-cause mortality was also higher in the low-income[aHR(95%CI):2.79(2.70–2.88)]and middle-income[aHR(95%CI):1.59(1.53–1.65)]groups.Older age,male sex,obesity,smoking,alcohol-related disorders,hypertension,dyslipidemia,gout,and psychotic disorders were significantly associated with increased risks of both young-onset T2D and mortality.CONCLUSION This nationwide cohort study demonstrated that young people from low-income and middle-income groups had a higher risk of youth-onset T2D and mortality than those from the high-income group.展开更多
The argument of this study is that social capital is a key factor of health literacy. Data came from an island-wide sample. Position generator was adopted to measure social capital. A regression model is constructed t...The argument of this study is that social capital is a key factor of health literacy. Data came from an island-wide sample. Position generator was adopted to measure social capital. A regression model is constructed to test the social capital which is known as a robust predictor of health literacy after controlling gender, age, education, income, and health communication ability. The results reveal that female, higher education, and better health communication ability are also correlated with health literacy. Implications for public health are discussed.展开更多
Objective:Although evidence has already demonstrated that the performance of Health Deliv- ery System(HDS) varies widely across nations,relatively little is known about the factors that give rise to these variations a...Objective:Although evidence has already demonstrated that the performance of Health Deliv- ery System(HDS) varies widely across nations,relatively little is known about the factors that give rise to these variations and the key point to improve the performance besides adjusting system structure.By setup of HDS performance measurement system on the base of association of financial,social,and environmental characteristics,we construct system dynamic model of HDS to simulate the invention policies.Methods: Performance measures were collected from HDS in 31 regions of China and combined with secondary data sources.Multivariate,linear,nonlinear regression and factor analysis models were used to estimate associ- ations between system characteristics and the performance.Results:Performance varied significantly with the size,financial resources and organizational structure of HDS.Performance measurement system of health delivery system was developed to give the rank of all Chinese regions.Conclusion:Performance measurement system of HDS is the basic of HDS modeling by system dynamic.展开更多
Objectives:This study was to longitudinally investigate the association between occupational change trajectories and mental health in the Korean population aged 45 years and older from the Korean Longitudinal Study of...Objectives:This study was to longitudinally investigate the association between occupational change trajectories and mental health in the Korean population aged 45 years and older from the Korean Longitudinal Study of Aging(KLo-SA).Methods:After excluding missing values,the data of 6,224 participants from thefirst to eighth waves of the KLo-SA were analyzed using t-test,Analysis of variance(ANOVA),Group-based Trajectory Model(GBTM)from 1–5th KLoSA and Time-Lagged Generalized estimating equation(GEE)model from 5–8th KLoSA to analyze the association between occupational change trajectories and mental health in the Korean population aged 45 years and older.Results:An analysis of the association between occupational change trajectories and mental health demonstrated that,among all age group,the“sustained in unemployment”group had a worse MMSE and CESD score compared to“sustained WC”group.unlike the under-54 age group,those aged≥55 years demonstrated reductions in the MMSE and CESD scores in the sustained unemployment and the changed working condition from Standard BC to Unemployment groups,whereas those who underwent a change from the Standard WC to unemployment group only demonstrated a reduction in MMSE scores.Conclusions:There was a close relationship between occupational change trajectories and mental health.Therefore,this study can serve as the foundation for policies and institutional measures to manage the deteriorate mental health in the late middle-aged and older population.展开更多
The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of Natio...The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of National City Community Health Service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms oflB alloca- tion quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.展开更多
Background: Dual Practice (DP) allows full-time public sector doctors to concurrently offer the same clinical services in the private sector. The debate against this practice seems to be largely influenced by its pote...Background: Dual Practice (DP) allows full-time public sector doctors to concurrently offer the same clinical services in the private sector. The debate against this practice seems to be largely influenced by its potential to reduce the contracted hours in the public sector and shift attention to private work. Purpose: The purpose of this secondary research is to estimate the monetary value of hours lost to the Nigerian public healthcare system when full-time government employee doctors are engaged in private practice. It attempts to quantify the amount of resource outflow from the public system due to absences and lateness arising from competition for time between the public system’s contracted hours and private practice. Methods: Sensitivity analysis in Excel 2010 was used to calculate doctors’ hourly pay in the public sector using the 2015 Consolidated Medical Salary Structure for medical and dental officers in Nigeria’s federal public service. The parameters used for the calculation were the official 40-hour working week and the average monthly gross pay of doctors on different grade levels. Hypothetical scenarios of hours lost due to absences associated with DP were created. The value of different hypothetical hour losses by the percentage of doctors assumed to engage in dual practice across all doctor grade levels was then computed. Results: The estimated annual value of hours lost from dual practice to a single public tertiary care hospital was N4,851,754 or 15,855 USD (best case scenario) and N19,407,017 or 63,422 USD (worst case scenario) for the normal routine work and N1,800,133 or 5883 USD (best case scenario) and N3,600,266 or 11,766 USD (worst case scenario) for the on-call duty. Conclusion: The government may have been paying salaries for large volumes of work not rendered in the public sector. The overall financial impact of dual practice in the Nigerian public system might be negative.展开更多
In the current socio-economic scenario characterized by a growing shortage of resources and progressive budget constraints, the need to better coordinate processes in health institutions appears as a relevant aspect t...In the current socio-economic scenario characterized by a growing shortage of resources and progressive budget constraints, the need to better coordinate processes in health institutions appears as a relevant aspect to ensure the future sustainability of system. In this sense, Relational Coordination(RC) provides a valuable opportunity for the reconfiguration of clinical guidelines concerning isolated single-level considerations. In this research the RC model has been applied to explain best results in the process of diagnosing and offering clinical treatments for lung cancer. Lung cancer presents the higher rates of tumor's mortality worldwide. Through unstructured and informal interviews with clinicians at both levels(Primary/Specialist Care), a diagnosis of the situation in relation to joint management of lung cancer is provided. Solutions of continuity in terms of coordination are explained due to the observation of lack of effective knowledge transfer between the two levels. It is this disconnection which justifies the introduction of a modified model of RC for the study and implementation of transfer relations between the knowledge holders, in order to structure consolidated and cooperative evidence-based models that lead to a substantial shortening in the response times with a marked outcomes improvement. To our knowledge, the application of this model to a Public Health problem bringing together both levels of care, hasn't been made till now.展开更多
Background: The United Arab Emirates aims to provide “world-class healthcare” to its citizens. This study aims to determine the association between overall satisfaction and various aspects of healthcare services in ...Background: The United Arab Emirates aims to provide “world-class healthcare” to its citizens. This study aims to determine the association between overall satisfaction and various aspects of healthcare services in the United Arab Emirates on a country level. Methods: The data was collected from 5855 respondents on the affordability, quality, accessibility, and responsiveness dimensions of health care. Besides frequency tables and descriptive statistics, statistical methods, such as Principal Component Analysis and Multiple Regression, were used to reduce and model the association between dependent (overall satisfaction) and independent (affordability, quality, accessibility, and responsiveness) variables. Results: The preliminary analysis using frequency tables and descriptive clearly highlighted the uncertainty associated with affordability and responsiveness dimensions of healthcare provision in the country. Analysis of variance and t-test results indicated statistically significant differences between perceptions of the respondents based on the socio-demographic factors and other factors such as the kind of insurance held by respondents, having a designated family physician, recent medical visits in the UAE, and intention to go back to home countries for medical treatment. The findings indicated higher satisfaction levels with quality and accessibility and lower satisfaction levels with affordability and responsiveness. Recommendations are provided to address the latter two factors. Conclusion: The study identifies healthcare service provision issues in the United Arab Emirates and recommends enhancing affordability and responsiveness.展开更多
Since the declaration of the Covid-19 pandemic by the World Health Organization on March 11, 2020, the coronavirus has upended communities and dramatically changed people’s daily endeavors across the globe [<a hre...Since the declaration of the Covid-19 pandemic by the World Health Organization on March 11, 2020, the coronavirus has upended communities and dramatically changed people’s daily endeavors across the globe [<a href="#ref1">1]. The current Covid-19 circumstances are occasioned by social realities such as the proliferation of misinformation, social inequalities, and nations’ inability to prepare for unprecedented crises such as the coronavirus. While Covid-19 has managed to elicit anxiety, cause illnesses and deaths, different sectors, individuals, and health dockets utilize technology to combat the pandemic. As we advance, there will be a need for a critical social understanding of how technology can be used to apprehend global crises such as coronavirus. To comprehend how technology is being used to address the coronavirus crises, the current paper assesses, evaluates, and rates the Covid-19 website developed by the Ministry of Health of Saudi Arabia [<a href="#ref2">2].展开更多
Objective: Out of pocket expenditure is the primary means of financing healthcare in middle and low-income countries. The 2021 government health expenditure in Nigeria at 4.52% falls short of the 15% recommendation of...Objective: Out of pocket expenditure is the primary means of financing healthcare in middle and low-income countries. The 2021 government health expenditure in Nigeria at 4.52% falls short of the 15% recommendation of the 2001 Abuja Declaration. This paper examines healthcare purchasing in Nigeria, in order to explore how resources were allocated and create better insight into healthcare purchasing for universal health coverage. Data Source/Study Setting: The study was conducted in the Federal Capital Territory and three states—Lagos, Enugu and Sokoto. Study Design: A cross sectional method was used to examine health purchasing functions in Nigeria. Key informant interviews and review of grey and published literature on health financing in the selected study areas. Data Collection Methods: Primary data were collected from relevant stakeholders across the selected study areas, using a structured interview guide. A search of grey and published literature gave a total of 57 references. Principal Findings: The NHIS has a clearly articulated benefit package, for its formal sector and pro-poor BHCPF program. NHIS covers only about 5% of the Nigerian population. BHCPF (SOML) program targets the bottom 40% of Nigerians on paper, but there is no specific design for reaching them. The NHIS uses both public and private sector providers. It is not clear which providers are used for the BHCPF (SOML) program. The NHIS uses actuarially calculated capitations for primary care services and market-based fee-for-service rates for reimbursing secondary and tertiary care. BHCPF (SOML) uses a macroscale pay-for-performance mechanism to reward states achieving specific health outcomes. Conclusion: Health purchasing functions have serious implication for UHC. However, health care provision in Nigeria is not pro-poor and government efforts do not promote efficiency. Available option is prioritization of health initiatives that ensure value for money through performance-based financing and partnering with the private sector.展开更多
Introduction: Khat chewing is believed to be rapidly increasing worldwide. Worldwide, it is estimated that 10 million people consume khat daily. Khat chewing practice renders certain influence on physical and psycholo...Introduction: Khat chewing is believed to be rapidly increasing worldwide. Worldwide, it is estimated that 10 million people consume khat daily. Khat chewing practice renders certain influence on physical and psychological well being of the community and it can cause more serious adverse psychiatric, cardiovascular, dental and gastrointestinal effects. The recent sharp increase in khat consumption may not only affect the health of individuals but could also have serious socio-economic consequences. This study was conducted to assess prevalence of khat chewing practice, its associated factors and perceived health effects among communities in Dera woreda, Amhara region, Ethiopia 2013. Methods: Community-based cross-sectional study was conducted by using both quantitative and qualitative method of data. The sample size for quantitative was determined by using single population proportion formula and the households were selected by systematic sampling method and in the selected household, one respondent was selected by lottery among members of household aged 15 years and above. Data were collected by means of a pretested questionnaire;analysis was carried out using SPSS version 16. For the qualitative part ten in-depth interviews were conducted on purposely selected individuals and sample size for this method was determined through continuing to interview participants until no new information was obtained. Results: The response rate was 98.3%. Current prevalence of khat chewing practice was 17%. Males were more likely to chew khat (AOR, 18.53;95%CI, 7.20-47.66) compared to females. Muslims were more likely to chew khat (AOR, 4.34;95%CI, 2.07-9.11) compared to Orthodox Christians. Respondents who had family member chewing khat were more likely to chew khat (AOR, 2.67;95%CI, 1.15-6.21) compared to family member without a chewer. Among all the respondents, 92.8% perceived the health effects of khat chewing practice. Respondents who did not perceive health effect of khat were 5 times more likely to chew khat (AOR = 5.10, 95%CI;1.64-15.5) compared to those who perceived health effect of khat. Conclusions: The prevalence of khat chewing practice was 17% with high proportion of the khat chewers found in the urban setting. Sex, religion, residence, family chewing habit and perceived health effect were significantly associated factors with khat chewing practice. In this study 92.8% of the respondents perceived that khat chewing practice had harmful effects on health and the perceived health effects reported were sleeping disorder, hallucination, tooth staining, anxiety, and loss of appetite, depression, constipation, gastritis, hypertension and psychosis.展开更多
Gender-specific differences in the prevalence,incidence,comorbidities,prognosis,severity,risk factors,drug-related aspects and outcomes of various medical conditions are well documented.We present a literature review ...Gender-specific differences in the prevalence,incidence,comorbidities,prognosis,severity,risk factors,drug-related aspects and outcomes of various medical conditions are well documented.We present a literature review on the extent to which research in this field has developed over the years,and reveal gaps in gender-sensitive awareness between the clinical portrayal and the translation into gender-specific treatment regimens,guidelines and into gender-oriented preventive strategies and health policies.Subsequently,through the lens of gender,we describe these domains in detail for four selected medical conditions:Asthma,obesity and overweight,chronic kidney disease and coronavirus disease 2019.As some of the key gender differences become more apparent during adolescence,we focus on this developmental stage.Finally,we propose a model which is based on three influential issues:(1)Investigating gender-specific medical profiles of related health conditions,rather than a single disease;(2)The dynamics of gender disparities across developmental stages;and(3)An integrative approach which takes into account additional risk factors(ethnicity,socio-demographic variables,minorities,lifestyle habits etc.).Increasing the awareness of gender-specific medicine in daily practice and in tailored guidelines,already among adolescents,may reduce inequities,facilitate the prediction of future trends and properly address the characteristics and needs of certain subpopulations within each gender.展开更多
Background: Any healthcare facility must be prepared to handle a dramatic increase in deaths that can be produced by a catastrophic disaster. A mass fatality incident (MFI) will significantly increase the usual number...Background: Any healthcare facility must be prepared to handle a dramatic increase in deaths that can be produced by a catastrophic disaster. A mass fatality incident (MFI) will significantly increase the usual number of deaths that hospitals or forensic science services can manage on a daily basis. A survey was conducted to assess the hospital emergency department level of preparedness to deal with an MFI. Objective: To examine healthcare facilities level of preparedness for an MFI and morgue capacity. Methods: A total of 39 out of a sample of 44 hospitals participated in the study. Seven questionnaires were administered to explore: hospital general characteristics;emergency plans;equipment and infrastructure;collaborative agreements;personnel trainings;emergency communications;laboratory facilities;treatment protocols;security;and, epidemiologic surveillance. Results: Three-fourths (79.5%) of the healthcare facilities reported having a morgue, their average storage capacity was of three bodies. More than two-thirds (66.7%) of the institutions stated that they could not increase their morgue’s capacity. Most installations without a morgue do not possess an agreement with any other institution for the management of bodies. Hospitals have a very limited number of body bags utilized for the handling and transport of bodies. Conclusion: Most of healthcare facilities have morgues, but there are limitations with the current capacity and the lack of resources to increase their capacity in case of a disaster. Management of an MFI must be part of every hospital’s emergency plan, and must include collaborative agreements with forensic authorities, emergency management and public health agencies, and the community.展开更多
文摘This letter discusses the study by Liu et al recently published in World Journal of Psychiatry,which examines the benefits of combining epirubicin(EPI)with mindfulness interventions for patients with urinary system tumors and depre-ssion.The study included 110 patients and compared an experimental group receiving EPI and a mindfulness intervention strategy with a control group treated with mitomycin and standard care.Results showed that the experimental group had significant improvements in immune function,tumor markers,depression severity,quality of life,cancer-related fatigue,and nursing satisfac-tion.Despite acknowledging the study limitations such as a relatively small sample size and a short duration,the study highlights the efficacy of integrating mindfulness interventions into cancer treatment strategies to enhance patient outcomes and address psychological distress.
基金Supported by National Natural Science Foundation of China(71774049).
文摘This paper systematically reviews the research progress of Advance Care Planning(ACP)in the field of lung cancer,and discusses its implementation status,key influencing factors and future development direction,including deepening of theoretical research,innovation of practice mode,optimization of policy support and cultural adaptation research.
基金supported by the National R&D Program for Cancer Control through the National Cancer Center funded by the Ministry of Health & Welfare, Republic of Korea (No. HA21C0225)。
文摘Objective: Regular cancer screening must be monitored to improve gastric cancer(GC) survival rates and maximize participation. This study examined adherence to regular GC screening over a 10-year period and identified the factors influencing adherence.Methods: This retrospective cohort study was conducted using data from the Korean National Cancer Screening Program(KNCSP) between 2011 and 2020. The total cohort comprised 400,113 adults aged 40 years who were newly eligible for and participated in GC screening in 2011. The participants were followed up for 10 years to assess their adherence to biennial screening recommendations. They were categorized into two groups: the nonregular screening(non-RS) group, which included individuals who did not participate in subsequent screenings, and the regular screening(RS) group, which included those who participated in at least one follow-up screening.Multiple logistic regression analyses were performed to identify the factors associated with adherence to regular GC screening.Results: Over 10 years, 59% of the participants completed at least four of the five recommended screenings,while 10% did not participate after their initial screening. Male participants had higher odds of non-adherence than females [adjusted odds ratio(aOR)=1.429, 95% confidence interval(95% CI): 1.394-1.464;P<0.001]. Nonadherence was more prevalent among self-employed individuals(aOR=1.208, P<0.001). Among males, those in the lowest income group were 1.267 times more likely to not undergo regular screening than those in the highest income group.Conclusions: Long-term adherence to regular GC screening in South Korea remains suboptimal.Socioeconomic disparities persist, highlighting the need for tailored interventions to improve adherence and enhance public health.
文摘Streptococcus pneumoniae is a known notorious cause of invasive pneumococcal diseases as well as asymptomatic host carriage. Efforts have been made to curb this infectious organism through various vaccine strategies. However, its several strains and serotypes have necessitated various vaccine schedules and updates in the USA and globally. The evolution in pneumococcal vaccine schedules is not without challenges, such as cost, vaccine hesitancy, uptake and global disparities. This narrative review synopsizes the history of the Pneumococcal Vaccine and changes in its schedules in the last two decades based on published data. We focused on the impact of pneumococcal vaccination on invasive pneumococcal diseases, historical limitations, current challenges and future directions. Despite advancements in vaccination against S. pneumoniae infections, some pertinent issues exist that need to be swiftly fixed, to reduce national and thus global burden of pneumococcal diseases.
基金Supported by Cancer Sucks,Bixby,Oklahoma Research Grant.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a global health concern,representing the second most common cause of malignancy-related mortality in the world.The primary cause of HCC in the United States is chronic infection with the hepatitis C virus(HCV).Clinical observations have established sex-based differences in HCV infection with the disease progressing more severely and more rapidly in males and postmenopausal females compared to premenopausal females,suggesting that estrogens and their receptors may play an important role in hepatic defenses and development of HCV-mediated HCC.However,the precise mechanism of estrogen protection and their effects on inflammation is poorly understood.AIM To determine whether estrogen receptor(ER)expression is correlated with the expression of tumor necrosis factor-alpha(TNF-α)in males and females with HCV-associated diseases.METHODS The role of ERs in modulating innate immune responses was investigated using human liver tissues with HCV/cirrhosis and HCV/HCC.Messenger RNA(mRNA)and protein(nuclear and cytoplasmic)expression were measured for all markers of interest and compared to normal human liver tissue samples.RESULTS ERβwas reported for the first time to have a greater mRNA expression than ERαin normal liver(P≤0.001).In addition,ERβmRNA expression was found to be decreased in diseased livers(P≤0.05),while TNF-αexpression was increased(P≤0.0001).Upon stratifying by sex within each disease group,ESR1 was found to be negatively correlated with ESR2 in females with HCV/cirrhosis(r=-0.84,P≤0.001),whereas males with HCV/cirrhosis were found to have a significant positive correlation(r=0.57,P≤0.05).ESR2 mRNA expression had a significant positive correlation with TNF-αin both HCV/cirrhosis(r=0.61,P≤0.001)and HCV/HCC patients(r=0.45,P≤0.05).CONCLUSION All together,these findings indicate that changes in ERβand TNF-αexpression are associated with worsening disease,and may be part of the sex-dependent factors in HCC pathogenesis.
文摘We investigated factors contributing to mobile phone dependence. To 139 medical students, we administered a self-reporting questionnaire designed to evaluate mobile phone dependence, health-related lifestyle, patterns of behavior, and depressive state. Multivariate logistic regression analysis revealed that scores for poor health-related lifestyle, Type A behavior pattern, and presence of depression are independently associated with degree of mobile phone dependency. These findings suggest that persons with an unhealthy lifestyle, Type A behavior traits, or depression might benefit from mobile phone use guidance.
基金Supported by Taipei Veterans General Hospital,No.V113C-166 and No.V114C-177National Science and Technology Council,R.O.C,No.NSTC113-2314-B-075-007-.
文摘BACKGROUND There are only a few studies on the influence of economic inequalities on youngonset type 2 diabetes(T2D).AIM To examine the impact of different family incomes on the development of youngonset T2D.METHODS We identified 7505336 young adults aged 20-39 years from the 2008 Taiwan region Health Insurance Research Database,China.The young adults were divided into low-income,middle-income,and high-income groups.Cox proportional hazards models were used to determine the risks of young-onset T2D and all-cause mortality in low-income and middle-income groups compared with the highincome group.RESULTS With a mean follow-up of 8.0 years,the incidence rates of young-onset T2D were 3.39,3.10,and 2.88 per 1000 person-years in the low-income,middle-income,and high-income groups,respectively.Compared with the high-income group,the risk of young-onset T2D was significantly higher in the low-income[adjusted hazard ratio(aHR)(95%CI):1.46(1.44–1.48)]and middle-income[aHR(95%CI):1.29(1.27–1.31)]groups.All-cause mortality was also higher in the low-income[aHR(95%CI):2.79(2.70–2.88)]and middle-income[aHR(95%CI):1.59(1.53–1.65)]groups.Older age,male sex,obesity,smoking,alcohol-related disorders,hypertension,dyslipidemia,gout,and psychotic disorders were significantly associated with increased risks of both young-onset T2D and mortality.CONCLUSION This nationwide cohort study demonstrated that young people from low-income and middle-income groups had a higher risk of youth-onset T2D and mortality than those from the high-income group.
文摘The argument of this study is that social capital is a key factor of health literacy. Data came from an island-wide sample. Position generator was adopted to measure social capital. A regression model is constructed to test the social capital which is known as a robust predictor of health literacy after controlling gender, age, education, income, and health communication ability. The results reveal that female, higher education, and better health communication ability are also correlated with health literacy. Implications for public health are discussed.
文摘Objective:Although evidence has already demonstrated that the performance of Health Deliv- ery System(HDS) varies widely across nations,relatively little is known about the factors that give rise to these variations and the key point to improve the performance besides adjusting system structure.By setup of HDS performance measurement system on the base of association of financial,social,and environmental characteristics,we construct system dynamic model of HDS to simulate the invention policies.Methods: Performance measures were collected from HDS in 31 regions of China and combined with secondary data sources.Multivariate,linear,nonlinear regression and factor analysis models were used to estimate associ- ations between system characteristics and the performance.Results:Performance varied significantly with the size,financial resources and organizational structure of HDS.Performance measurement system of health delivery system was developed to give the rank of all Chinese regions.Conclusion:Performance measurement system of HDS is the basic of HDS modeling by system dynamic.
文摘Objectives:This study was to longitudinally investigate the association between occupational change trajectories and mental health in the Korean population aged 45 years and older from the Korean Longitudinal Study of Aging(KLo-SA).Methods:After excluding missing values,the data of 6,224 participants from thefirst to eighth waves of the KLo-SA were analyzed using t-test,Analysis of variance(ANOVA),Group-based Trajectory Model(GBTM)from 1–5th KLoSA and Time-Lagged Generalized estimating equation(GEE)model from 5–8th KLoSA to analyze the association between occupational change trajectories and mental health in the Korean population aged 45 years and older.Results:An analysis of the association between occupational change trajectories and mental health demonstrated that,among all age group,the“sustained in unemployment”group had a worse MMSE and CESD score compared to“sustained WC”group.unlike the under-54 age group,those aged≥55 years demonstrated reductions in the MMSE and CESD scores in the sustained unemployment and the changed working condition from Standard BC to Unemployment groups,whereas those who underwent a change from the Standard WC to unemployment group only demonstrated a reduction in MMSE scores.Conclusions:There was a close relationship between occupational change trajectories and mental health.Therefore,this study can serve as the foundation for policies and institutional measures to manage the deteriorate mental health in the late middle-aged and older population.
基金The Baseline Survey of "The National Urban Community Health Service System Building Project" was funded by Ministry Of Health of China
文摘The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of National City Community Health Service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms oflB alloca- tion quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.
文摘Background: Dual Practice (DP) allows full-time public sector doctors to concurrently offer the same clinical services in the private sector. The debate against this practice seems to be largely influenced by its potential to reduce the contracted hours in the public sector and shift attention to private work. Purpose: The purpose of this secondary research is to estimate the monetary value of hours lost to the Nigerian public healthcare system when full-time government employee doctors are engaged in private practice. It attempts to quantify the amount of resource outflow from the public system due to absences and lateness arising from competition for time between the public system’s contracted hours and private practice. Methods: Sensitivity analysis in Excel 2010 was used to calculate doctors’ hourly pay in the public sector using the 2015 Consolidated Medical Salary Structure for medical and dental officers in Nigeria’s federal public service. The parameters used for the calculation were the official 40-hour working week and the average monthly gross pay of doctors on different grade levels. Hypothetical scenarios of hours lost due to absences associated with DP were created. The value of different hypothetical hour losses by the percentage of doctors assumed to engage in dual practice across all doctor grade levels was then computed. Results: The estimated annual value of hours lost from dual practice to a single public tertiary care hospital was N4,851,754 or 15,855 USD (best case scenario) and N19,407,017 or 63,422 USD (worst case scenario) for the normal routine work and N1,800,133 or 5883 USD (best case scenario) and N3,600,266 or 11,766 USD (worst case scenario) for the on-call duty. Conclusion: The government may have been paying salaries for large volumes of work not rendered in the public sector. The overall financial impact of dual practice in the Nigerian public system might be negative.
文摘In the current socio-economic scenario characterized by a growing shortage of resources and progressive budget constraints, the need to better coordinate processes in health institutions appears as a relevant aspect to ensure the future sustainability of system. In this sense, Relational Coordination(RC) provides a valuable opportunity for the reconfiguration of clinical guidelines concerning isolated single-level considerations. In this research the RC model has been applied to explain best results in the process of diagnosing and offering clinical treatments for lung cancer. Lung cancer presents the higher rates of tumor's mortality worldwide. Through unstructured and informal interviews with clinicians at both levels(Primary/Specialist Care), a diagnosis of the situation in relation to joint management of lung cancer is provided. Solutions of continuity in terms of coordination are explained due to the observation of lack of effective knowledge transfer between the two levels. It is this disconnection which justifies the introduction of a modified model of RC for the study and implementation of transfer relations between the knowledge holders, in order to structure consolidated and cooperative evidence-based models that lead to a substantial shortening in the response times with a marked outcomes improvement. To our knowledge, the application of this model to a Public Health problem bringing together both levels of care, hasn't been made till now.
文摘Background: The United Arab Emirates aims to provide “world-class healthcare” to its citizens. This study aims to determine the association between overall satisfaction and various aspects of healthcare services in the United Arab Emirates on a country level. Methods: The data was collected from 5855 respondents on the affordability, quality, accessibility, and responsiveness dimensions of health care. Besides frequency tables and descriptive statistics, statistical methods, such as Principal Component Analysis and Multiple Regression, were used to reduce and model the association between dependent (overall satisfaction) and independent (affordability, quality, accessibility, and responsiveness) variables. Results: The preliminary analysis using frequency tables and descriptive clearly highlighted the uncertainty associated with affordability and responsiveness dimensions of healthcare provision in the country. Analysis of variance and t-test results indicated statistically significant differences between perceptions of the respondents based on the socio-demographic factors and other factors such as the kind of insurance held by respondents, having a designated family physician, recent medical visits in the UAE, and intention to go back to home countries for medical treatment. The findings indicated higher satisfaction levels with quality and accessibility and lower satisfaction levels with affordability and responsiveness. Recommendations are provided to address the latter two factors. Conclusion: The study identifies healthcare service provision issues in the United Arab Emirates and recommends enhancing affordability and responsiveness.
文摘Since the declaration of the Covid-19 pandemic by the World Health Organization on March 11, 2020, the coronavirus has upended communities and dramatically changed people’s daily endeavors across the globe [<a href="#ref1">1]. The current Covid-19 circumstances are occasioned by social realities such as the proliferation of misinformation, social inequalities, and nations’ inability to prepare for unprecedented crises such as the coronavirus. While Covid-19 has managed to elicit anxiety, cause illnesses and deaths, different sectors, individuals, and health dockets utilize technology to combat the pandemic. As we advance, there will be a need for a critical social understanding of how technology can be used to apprehend global crises such as coronavirus. To comprehend how technology is being used to address the coronavirus crises, the current paper assesses, evaluates, and rates the Covid-19 website developed by the Ministry of Health of Saudi Arabia [<a href="#ref2">2].
文摘Objective: Out of pocket expenditure is the primary means of financing healthcare in middle and low-income countries. The 2021 government health expenditure in Nigeria at 4.52% falls short of the 15% recommendation of the 2001 Abuja Declaration. This paper examines healthcare purchasing in Nigeria, in order to explore how resources were allocated and create better insight into healthcare purchasing for universal health coverage. Data Source/Study Setting: The study was conducted in the Federal Capital Territory and three states—Lagos, Enugu and Sokoto. Study Design: A cross sectional method was used to examine health purchasing functions in Nigeria. Key informant interviews and review of grey and published literature on health financing in the selected study areas. Data Collection Methods: Primary data were collected from relevant stakeholders across the selected study areas, using a structured interview guide. A search of grey and published literature gave a total of 57 references. Principal Findings: The NHIS has a clearly articulated benefit package, for its formal sector and pro-poor BHCPF program. NHIS covers only about 5% of the Nigerian population. BHCPF (SOML) program targets the bottom 40% of Nigerians on paper, but there is no specific design for reaching them. The NHIS uses both public and private sector providers. It is not clear which providers are used for the BHCPF (SOML) program. The NHIS uses actuarially calculated capitations for primary care services and market-based fee-for-service rates for reimbursing secondary and tertiary care. BHCPF (SOML) uses a macroscale pay-for-performance mechanism to reward states achieving specific health outcomes. Conclusion: Health purchasing functions have serious implication for UHC. However, health care provision in Nigeria is not pro-poor and government efforts do not promote efficiency. Available option is prioritization of health initiatives that ensure value for money through performance-based financing and partnering with the private sector.
文摘Introduction: Khat chewing is believed to be rapidly increasing worldwide. Worldwide, it is estimated that 10 million people consume khat daily. Khat chewing practice renders certain influence on physical and psychological well being of the community and it can cause more serious adverse psychiatric, cardiovascular, dental and gastrointestinal effects. The recent sharp increase in khat consumption may not only affect the health of individuals but could also have serious socio-economic consequences. This study was conducted to assess prevalence of khat chewing practice, its associated factors and perceived health effects among communities in Dera woreda, Amhara region, Ethiopia 2013. Methods: Community-based cross-sectional study was conducted by using both quantitative and qualitative method of data. The sample size for quantitative was determined by using single population proportion formula and the households were selected by systematic sampling method and in the selected household, one respondent was selected by lottery among members of household aged 15 years and above. Data were collected by means of a pretested questionnaire;analysis was carried out using SPSS version 16. For the qualitative part ten in-depth interviews were conducted on purposely selected individuals and sample size for this method was determined through continuing to interview participants until no new information was obtained. Results: The response rate was 98.3%. Current prevalence of khat chewing practice was 17%. Males were more likely to chew khat (AOR, 18.53;95%CI, 7.20-47.66) compared to females. Muslims were more likely to chew khat (AOR, 4.34;95%CI, 2.07-9.11) compared to Orthodox Christians. Respondents who had family member chewing khat were more likely to chew khat (AOR, 2.67;95%CI, 1.15-6.21) compared to family member without a chewer. Among all the respondents, 92.8% perceived the health effects of khat chewing practice. Respondents who did not perceive health effect of khat were 5 times more likely to chew khat (AOR = 5.10, 95%CI;1.64-15.5) compared to those who perceived health effect of khat. Conclusions: The prevalence of khat chewing practice was 17% with high proportion of the khat chewers found in the urban setting. Sex, religion, residence, family chewing habit and perceived health effect were significantly associated factors with khat chewing practice. In this study 92.8% of the respondents perceived that khat chewing practice had harmful effects on health and the perceived health effects reported were sleeping disorder, hallucination, tooth staining, anxiety, and loss of appetite, depression, constipation, gastritis, hypertension and psychosis.
文摘Gender-specific differences in the prevalence,incidence,comorbidities,prognosis,severity,risk factors,drug-related aspects and outcomes of various medical conditions are well documented.We present a literature review on the extent to which research in this field has developed over the years,and reveal gaps in gender-sensitive awareness between the clinical portrayal and the translation into gender-specific treatment regimens,guidelines and into gender-oriented preventive strategies and health policies.Subsequently,through the lens of gender,we describe these domains in detail for four selected medical conditions:Asthma,obesity and overweight,chronic kidney disease and coronavirus disease 2019.As some of the key gender differences become more apparent during adolescence,we focus on this developmental stage.Finally,we propose a model which is based on three influential issues:(1)Investigating gender-specific medical profiles of related health conditions,rather than a single disease;(2)The dynamics of gender disparities across developmental stages;and(3)An integrative approach which takes into account additional risk factors(ethnicity,socio-demographic variables,minorities,lifestyle habits etc.).Increasing the awareness of gender-specific medicine in daily practice and in tailored guidelines,already among adolescents,may reduce inequities,facilitate the prediction of future trends and properly address the characteristics and needs of certain subpopulations within each gender.
文摘Background: Any healthcare facility must be prepared to handle a dramatic increase in deaths that can be produced by a catastrophic disaster. A mass fatality incident (MFI) will significantly increase the usual number of deaths that hospitals or forensic science services can manage on a daily basis. A survey was conducted to assess the hospital emergency department level of preparedness to deal with an MFI. Objective: To examine healthcare facilities level of preparedness for an MFI and morgue capacity. Methods: A total of 39 out of a sample of 44 hospitals participated in the study. Seven questionnaires were administered to explore: hospital general characteristics;emergency plans;equipment and infrastructure;collaborative agreements;personnel trainings;emergency communications;laboratory facilities;treatment protocols;security;and, epidemiologic surveillance. Results: Three-fourths (79.5%) of the healthcare facilities reported having a morgue, their average storage capacity was of three bodies. More than two-thirds (66.7%) of the institutions stated that they could not increase their morgue’s capacity. Most installations without a morgue do not possess an agreement with any other institution for the management of bodies. Hospitals have a very limited number of body bags utilized for the handling and transport of bodies. Conclusion: Most of healthcare facilities have morgues, but there are limitations with the current capacity and the lack of resources to increase their capacity in case of a disaster. Management of an MFI must be part of every hospital’s emergency plan, and must include collaborative agreements with forensic authorities, emergency management and public health agencies, and the community.
